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An informed argument for reworking the broken market†'based U.S. healthcare system by making cost and quality more transparent The United States has the most expensive healthcare system in the world. While policy makers have argued over who is at fault for this, the system has been quietly moving toward high†'deductible insurance plans that require patients to pay large amounts out of pocket before insurance kicks in. The idea behind this shift is that patients will become better consumers of healthcare when forced to pay for their medical expenses. Laying bare the perils of the current situation, Peter A. Ubel-a physician and behavioral scientist-notes that even when patients have time to shop around, healthcare costs remain largely opaque, difficult to access, and hard to compare. Arguing for a middle path between a market†'based and a completely free system, Ubel envisions more transparent, smarter healthcare plans that tie the prices of treatments to the value they provide so that people can afford to receive the care they deserve

AbstractOver the last decade, health care in many parts of the world has shifted toward a more patient-centric, consumeristic model, marked by an emphasis on choice and a proliferation of typical consumer-facing information (e.g. price and quality data). However, while the 'patients as consumers' perspective is an apt one, there are crucial differences between health care and typical consumer domains that warrant special consideration by policy-makers and researchers alike. This article discusses some of these differences and explores the challenges that consumers (i.e. patients) face when making trade-offs between price and quality.

AbstractIn close, disputed elections, outcomes can depend on determinations of voter intent for ballots that have been filled out improperly. We surveyed 899 adult Minnesotans during a time when the state's U.S. Senate election was still disputed and presented them with ambiguous ballots similar to ballots under dispute in the same election. We randomized participants to three experimental groups, across which we varied the names on the ballot. We found that participants' judgments of voter intent were strongly biased by their voting preferences (p < .002 in all four ballots).

Despite the salience of health disparities in media and policy discourse, little previous research has investigated if imagery associating an illness with a certain racial group influences public perceptions. This study evaluated the influence of the media's presentation of the causes of type 2 diabetes and its implicit racial associations on attitudes toward people with diabetes and preferences toward research spending. Survey participants who viewed an article on genetic causation or social determinants of diabetes were more likely to support increased government spending on research than those viewing an article with no causal language, while participants viewing an article on behavioral choices were more likely to attribute negative stereotypes to people with diabetes. Participants who viewed a photo of a black woman accompanying the article were less likely to endorse negative stereotypes than those viewing a photo of a white woman, but those who viewed a photo of a glucose-testing device expressed the lowest negative stereotypes. The effect of social determinants language was significantly different for blacks and whites, lowering stereotypes only among blacks. Emphasizing the behavioral causes of diabetes, as is common in media coverage, may perpetuate negative stereotypes. While drawing attention to the social determinants that shape these behaviors could mitigate stereotypes, this strategy is unlikely to influence the public uniformly.

Framing health problems in terms of the social determinants of health aims to shift policy attention to nonmedical strategies to improve population health, yet little is known about how the public responds to these messages. We conducted an experiment to test the effect of a news article describing the social determinants of type 2 diabetes on the public's support for diabetes prevention strategies. We found that exposure to the social determinants message led to a divergence between Republicans' and Democrats' opinions, relative to their opinions after viewing an article with no message about the causes of diabetes. These results signify that increasing public awareness of the social determinants of health may not uniformly increase public support for policy action.

Reports of randomized clinical trials often use survival curves to summarize clinical outcomes over time and graphically demonstrate evidence of treatment effectiveness. Survival curves can also be used in patient communications to display how health risks accumulate over time. In a randomized survey experiment, administered online, we tested whether people viewing survival curves appropriately adjust their risk perceptions to account for the duration shown. Internet users (N= 864) were recruited from a demographically balanced U.S. panel. Participants read about a hypothetical disease and then viewed one of four survival graphs that displayed mortality risks with and without treatment. Survival graphs showed either a visually large or visually small difference between treatments and were labeled to represent either 5‐year or 15‐year risk statistics. Participants then provided ratings of disease seriousness, as well as treatment effectiveness for each possible treatment. Variations in ratings corresponded more with visual dissimilarity than with changes in the statistical risk exhibited, with participants perceiving somewhat greater disease seriousness and significant differences in treatment effectiveness in large visual difference graphs. We conclude that when people interpret survival curves, they often fail to sufficiently account for the timeframe represented and perceive more risk and larger differences when identical risks are displayed over longer periods of time. We recommend that all presentations of survival graphics, whether to patients, physicians, or scientists, emphasize duration information (e.g., in the title) and remind readers that attending to graph axis labels is the only way to pierce these visual illusions.

Physicians are increasingly asked to use cost‐effectiveness information when evaluating alternative health care interventions. Little is known about how the way such information is presented can influence medical decision making. We presented physicians with hypothetical screening scenarios with multiple options, varying the type of cost‐effectiveness ratios provided as well as whether the scenarios described cancer screening settings that were familiar or unfamiliar. Half the scenarios used average cost‐effectiveness ratios, as commonly reported, calculating benefits and costs relative to a no‐screening option. The other half used the preferred incremental cost‐effectiveness ratios, with each option's benefits and costs calculated relative to the next best alternative. Relative to average cost‐effectiveness ratios, incremental cost‐effectiveness information significantly reduced preference for the most expensive screening strategies in two of three unfamiliar scenarios. No such difference was found for familiar scenarios, for which physicians likely have established practice patterns. These results suggest that, in unfamiliar settings, average cost‐effectiveness ratios as reported in many analyses reported in the literature can hide the often high price for achieving incremental health care goals, potentially causing physicians to choose interventions with poor cost effectiveness.

AbstractMany policy interventions that address rising obesity levels in the United States have been designed to provide consumers with more nutrition information, with the goal of encouraging consumers to decrease their caloric intake. We discuss existing information‐provision measures and suggest that they are likely to have little‐to‐modest impact on encouraging lower caloric intake, because making use of such information requires understanding and/or motivation, which many consumers lack, as well as self‐control, which is a limited resource. We highlight several phenomena from the behavioral economics literature (present‐biased preferences, visceral factors, and status quo bias) and explain how awareness of these behavioral phenomena can inform both more effective information‐provision policies and additional policies for regulating restaurants and public school cafeterias that move beyond information to nudge people towards healthier food choices.

Although scholarship on competitive framing acknowledges that framing is a dynamic process in which the early stages may matter most, very little research has focused on the dynamics of issue emergence. In this article, we draw on several literatures to develop theories for how controversy related to new issues will emerge and expand in news coverage. Through a comprehensive content analysis of 101 local newspapers across the fifty U.S. states, we explore the dynamic and evolving process wherein a new issue-the HPV vaccine-emerged into public discourse and a legislative debate over school requirements for vaccination began. We find that coverage of controversy is a function of proximity, driven primarily by events within a state, although external events also influence local coverage. We also find that the legislative discussion in the media did not necessarily start out as controversial, but as the issue evolved, we observe a large increase in the proliferation of both actors taking positions and the types of arguments made to influence debate. The findings yield important insight into issue emergence with implications for how future research might test competing frames to better understand how the presentation of controversy in the mass media affects public opinion. [Reprinted by permission; copyright Sage Publications Inc.]

Although scholarship on competitive framing acknowledges that framing is a dynamic process in which the early stages may matter most, very little research has focused on the dynamics of issue emergence. In this article, we draw on several literatures to develop theories for how controversy related to new issues will emerge and expand in news coverage. Through a comprehensive content analysis of 101 local newspapers across the fifty U.S. states, we explore the dynamic and evolving process wherein a new issue—the HPV vaccine—emerged into public discourse and a legislative debate over school requirements for vaccination began. We find that coverage of controversy is a function of proximity, driven primarily by events within a state, although external events also influence local coverage. We also find that the legislative discussion in the media did not necessarily start out as controversial, but as the issue evolved, we observe a large increase in the proliferation of both actors taking positions and the types of arguments made to influence debate. The findings yield important insight into issue emergence with implications for how future research might test competing frames to better understand how the presentation of controversy in the mass media affects public opinion.